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Cerebral vasospasm (CV) is the leading cause of death and disability in patients with subarachnoid hemorrhage (SAH). We suppose that clinical vasospasm disturbances could be detected by the increase in cerebral oxygen extractions (AVDO2), so in this study we tried to predict clinical CV appearances using jugular bulb oximetry monitoring.
Open prospective clinical study, from July 2009 to November 2009, in which 23 consecutive patients who underwent surgery for ruptured aneurysms were included; a jugular bulb catheter was placed in all patients. To calculate AVDO2, arterial and jugular bulb blood samples were taken every 12 hours. Demographics, neurological examination, WFNS grade, Fisher modified classification, aneurysm characteristics, vasospasm, and hemodynamic changes were collected. All patients presenting clinical vasospasm were treated by hypertensive, hemodilution and hypervolemic therapy (3H therapy). Adequate statistical tests were used.
From 23 patients, eight had neurologic deficits (35%), in all these patients AVDO2 significantly increased approximately 12 hours before the onset of clinical deficits (P < 0.01) and it was improved after administering 3H therapy. Two patients (8%) had clinical vasospasm but did not demonstrate a significant rise in AVDO2 (P < 0.68), all other patients (57%) did not present clinical vasospasm nor significant rising in AVDO2.
Increases in AVDO2 using jugular bulb oximetry monitoring could predict clinical vasospasm in aneurysmal SAH hours before its onset. A larger number of patients would confirm these results.